多种肿瘤标志物在肝脏疾病中的对比研究

目的：比较几种临床常用肿瘤标志物（TM）对肝脏良、恶性疾病的鉴别诊断能力。方法：回顾性分析6个TM（AFP、CEA、CA50、CA125、CA15—3和CA19—9）在421例肝脏良、恶性疾病中的浓度变化，绘制ROC曲线并进行Mann—Whitney U检验和二元Logistic回归分析。结果：肝囊肿病人第90百分位数的6个TM全部位于正常参考值范围内。与之相比，慢性肝炎患者6个TM均出现明显升高（P=0．000—0．032）。肝硬化较慢性肝炎病人CA125、CEA和CA19—9进一步升高（P〈0．05）。原发性肝癌较肝硬化只有AFP升高显著，ROC曲线下面积（0．733）最大，二元Logistic回归分析表明AFP是原发性肝癌的独立危险因子。转移性肝癌CEA较其他各疾病组明显升高（P〈0．001）。结论：AFP和CEA是鉴别原发性肝癌与其他肝脏疾病的主要TM；CA50、CA153、CA125和CA19—9在肝硬化和原发性肝癌患者中的浓度无显著差异，对具有肝硬化病史的患者进行TM分析时需慎重。

Comparative Study on Diagnostic Value of Several Serum Tumor Markers in Liver Diseases

Objective To compare the diagnostic capability of six commonly-used serum tumor markers (TM) in liver disease. Method Serum contents of six TMs, AFP, CEA, CA50, CA125, CA15-3 and CA19-9, were statistically analyzed with ROC curve, Mann-Whitney U-test and binary logistic regression in 421 patients with varidus kinds of benign or malignant liver diseases. Results Ninety percent of patients with hepatic cyst had all 6 TMs within normal reference range, while all the patients with chronic hepatitis had the 6 TMs increased significantly (P=0.000~0.032). Further increases in serum in CA125, CEA and CA19-9 contents were seen in patients with cirrhosis (P<0.05). AFP was the only TM with serum contents significantly higher in patients with primary liver cancer than those in patients with cirrhosis, and had the largest area under ROC curve (0.733). Logistic regression analysis revealed that AFP was an independent risk factor for primary liver cancer. CEA contents were very significantly higher in patients with metastatic liver cancer than in patients other liver with diseases (P<0.001). Conclusion AFP and CEA were the two most useful markers for the diagnosis of hepatic malignancy. CA50, CA153,CA125 and CA19-9 contents were increased to a similar degree in cirrhosis and primary liver cancer, so their usfulness for differential dragnosis was limited.